Updated: Wednesday 11 January 2006

Behavior Change Approaches

Behavior Change Approaches

While the specific behavior change strategy will certainly vary by country, HIP will bring together key stakeholders collectively to:

General barriers and motivations to performing the three key hygiene practices have been documented.Approaches based on this strategic behavior change approach will be based on available research and best practice data. HIP will continue to add to the knowledge base for these barriers and motivators.

Harm reduction model

HIP country interventions will apply and test a harm reduction model. Rather than promoting ideal hygiene behaviors that may not be feasible for priority audiences, HIP will apply the well-honed techniques of negotiating improved practices – working with communities and institutions influential on key practices – to identify feasible behaviors appropriate to the context that may not be 100 percent effective. This approach can encourage more individuals to adopt feasible practices.

This incremental behavior change approach to hygiene improvement compromises by promoting the practice of less than 100 percent adherence to behavior recommendations, or by promoting behaviors that are less than 100 percent efficacious in blocking pathogens. A non-hygiene example, in the area of exercise promotion, would be to promote adding a ten minute introduction of walking to the daily routine on two days per week, rather than promoting the CDC recommendation of 30 minutes of aerobic exercise at least four days per week. The goal is to introduce the ideal, but to have the adopter move incrementally toward this goal in manageable steps. For hygiene, this might mean promoting a water filter that is highly but not 100 percent efficacious, promoting latrines that meet minimum standards but do not adhere completely to VIP specifications, or promoting hand washing after defecation and food preparation rather than the 26 times a day that would be required for ideal hygiene practice.

In addition to formative research techniques to identify feasible behaviors, HIP will assess the context thoroughly though applying marketing analyses; epidemiological assessments; educational, environmental and organizational diagnoses; and administrative and policy assessments to assist in designing the components for the behavior change strategy.

Promoting all three key hygiene practices

HIP will promote the improved practice of all three hygiene behaviors, as possible given the country context. Targeting these particular multiple behaviors virtually demands a strategy that incorporates both individual and systems or community approaches.An intervention aimed at influencing washing hands with soap, for instance, would appropriately incorporate the expanded psychosocial approaches, based on increased knowledge and skills, increased perception of risk, sense of efficacy, and access to necessary products.All of these elements target the individual (and, when targeting children, caregivers). A person practicing effective hand hygiene can reduce fecal-oral contamination without the community around them participating. Individuals improving their own latrine use, however, would not necessarily yield improved health outcomes unless a critical mass of the surrounding community also used latrines and disposed of feces appropriately. To influence this behavior, a systems approach is appropriate. A systems approach can also help to make private behaviors public, which in turn exerts social pressure to try and maintain the improved hygiene practices, such as water disinfection. The above examples are not listed to imply a formulaic calculation of the best mix of approaches, rather to highlight that hygiene behavior change requires approaches involving mixed theory and practice.

The role of technology/products

Availability and supply of water, latrines, soap, water disinfectant technologies and other key products is critical to HIP’s behavior change approach. Finding solutions to improve hygiene behaviors can be easier or harder depending on the technology available. For example, promoting hand washing to households with piped water will be easier than to households with limited access to river water. In the latter example, the absence of technology makes the practice of hand washing more difficult, and locally-appropriate alternatives must be found that can still enable households to practice the behavior.

Sustaining improved hygiene practices

Sustained practices can be encouraged in a number of ways, but evidence indicates the most effective and long-lasting include (1) when visible rewards and positive outcomes can be seen by the practicing households and communities, e.g. five communities in Indonesia witnessed such a significant decrease in diarrheal disease after improving hand washing practices that they maintained this behavior over many years; and (2) when social change occurs within the community, i.e. increased social desirability of the behavior (practice by the elite) or achieved threshold practice by the population, e.g. communities in Bangladesh assess the value of their community based on the number of used and hygienic latrines.HIP will learn through formative research what motivations are most immediate and meaningful and incorporate those into programs.